Respiratory Therapy

Admission Application

We are no longer accepting printed applications. Please fill out the online form.

* Indicates required fields.

Prerequisite Declarations

Falsification or misuse of records and/or misrepresentation of facts on University forms and documents, including but not limited to, application forms, data sheets, ID cards, fee receipts, may result in disciplinary action and/or cancellation of registration. See Section 2.16 of Student Rights and Responsibilities: A Code of Student Behavior.

Contact Information
  1. Permanent Address *
  1. Send correspondence to: *
High School Information
Post Secondary Education (Since high school)
  1. First Institution
    1. Date From
    2. Date To
    3. Name of Institution
    4. City and State
    5. Major
    6. Credential Earned
    7. GPA
  2. Second Institution
    1. Date From
    2. Date To
    3. Name of Institution
    4. City and State
    5. Major
    6. Credential Earned
    7. GPA
  3. Third Institution
    1. Date From
    2. Date To
    3. Name of Institution
    4. City and State
    5. Major
    6. Credential Earned
    7. GPA

Official transcripts of high school or GED scores and all post high school education must be submitted to the Office of Admission, 8600 University Boulevard, Evansville, IN 47712.

Employment History

List present or most recent employment first.

  1. First Position
    1. Date From
    2. Date To
    3. Title of Position
    4. Employer
    5. City and State
  2. Second Position
    1. Date From
    2. Date To
    3. Title of Position
    4. Employer
    5. City and State
  3. Third Position
    1. Date From
    2. Date To
    3. Title of Position
    4. Employer
    5. City and State
Community Activities

List community organizations, board memberships, offices held, and professional activities that serve the community. Include activities during the last three years.

  1. First Position
    1. Organization/Association
    2. Description of Duties
    3. Date From
    4. Date To
  2. Second Position
    1. Organization/Association
    2. Description of Duties
    3. Date From
    4. Date To

Career Questionnaire
  1. Have you previously applied to a USI College of Nursing and Health Professions program or another university/college Respiratory Therapy program? *
  2. Have you started a Respiratory Therapy program at another university/college and not complete the program? *
USI Environment

USI works to maintain a safe environment for all members of the University community. The following questions will help us better maintain this environment.

  1. Have you ever been convicted of a misdemeanor, felony or other crime (excluding routine traffic offenses and convictions expunged or sealed by the sentencing court or juvenile court or otherwise protected from disclosure by the specific authority of law)? *
  2. Are any criminal charges currently pending against you? *

If your answer is "Yes" to any of these questions, you will be asked to provide additional information. Being convicted of a crime, pending criminal charges, probation, suspension, dismissal or expulsion do not serve as an absolute bar to admission, but will require additional evaluation.

  1. Have you been convicted of a sex offense against children? *
    (Requirements of Indiana Public Law 11-1994.)
Emergency Contact
Signature

By signing below I am verifying that all the above information is true and accurate to the best of my knowledge. I also authorize the Admission Committee to review and verify my application and academic records.

Submit Application
Important

Please return this application to:

Respiratory Therapy Program

University of Southern Indiana
College of Nursing and Health Professions
8600 University Boulevard, HP 2068
Evansville, IN 47712

All application materials must be received by the University of Southern Indiana before an admission decision can be made.

Application Deadline: October 1

It is the policy of the University of Southern Indiana to be in full compliance with all federal and state non-discrimination and equal opportunity laws, orders and regulations relating to race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity, or veteran status. Questions or concerns should be directed to the Affirmative Action Officer, USI Human Resources Department, University of Southern Indiana, 8600 University Boulevard, Evansville, Indiana 47712.

Application ID: F64EA670575129EFF23C1074900CCD9B